Left Bundle Branch Block after Transcatheter Aortic Valve Implantation (TAVI)

The introduction of the transcatheter aortic valve implantation (TAVI) has
proven to be a valuable alternative to surgical valve replacement in the older,
co-morbid patient with a high operative mortality risk. However, as a
consequence of the properties of the self-expanding stent, there is a high
incidence of newly-acquired left bundle branch block (LBBB) after TAVI
presumably caused by localised pressure of the stent on the ventricular septum.
The clinical consequence of this new-onset LBBB is not known , however in
general cardiology it is well appreciated that LBBB is an independent predictor
of cardiovascular disease and LBBB has been shown to induce dilatation of the
LV cavity and hypertrophy.
Secondly, the TAVI-induced LBBB is a proximal block of which the onset is
exactly known. These unique characteristics offer possibilities to study the
changes of left ventricular mechanical properties caused by LBBB in time.
Although extensively studied in animals, so far it has not been possible to do
so in patients with LBBB simply because the onset of the bundle branch block is
unknown. This knowledge can contribute to better understanding of LBBB in
general and the application of cardiac resynchronization therapy (CRT).
Thirdly, there is evidence that the depth of prosthesis implantation is a risk
factor for the development of TAVI-induced LBBB. Three-dimensional
transoesophagal echocardiography could be of additional value in defining
correct size and guiding placement of the aortic tissue valve.

1. to compare the extent of reversal of left ventricular remodelling at 3
months and 1 year after a TAVI procedure between patients with a TAVI-induced
LBBB and patients without a LBBB; 2. comparison of strain patterns in
TAVI-induced LBBB (as being a clear example of proximal LBBB) with that in a
group of CRT patients.

a single-centre, prospective, nonrandomized study.

both the TAVI intervention and the clinical and echocardiographic assessment
are part of routine clinical practice concerning the percutaneous aortic valve
replacement. The transesophagal echocardiography is also a standard procedure
during TAVI intervention. 3-Dimensional images are additionally recorded
without additional burden for the patient. Only the echocardiographic
examination performed within 1 week after the TAVI procedure is supplemental.
However, this examination will be performed during hospital stay and is in
general not considered as a burden by patients.